What is psychosis?
‘Psychosis’ is the term used to describe mental health problems that prevent an individual from thinking clearly and from being able to lucidly identify fact from fantasy. While psychosis is not diagnosed as a disorder itself, it is typically triggered by other conditions and so is usually identified by two main symptoms; hallucinations and delusions.
Hallucinations
Seeing, hearing or physically feeling something that isn’t there is known as a hallucination. Hallucinations may include:
- Seeing things that other people don’t - This could include a vision of an animal or religious figure, seeing people’s faces or viewing objects as distorted or as moving in a way that they wouldn’t normally.
- Hearing voices - The voices could be those of loved ones or complete strangers. There may be a single voice or many, and they could be kind and sensitive or malicious and intimidating.
- Experiencing sensations that other people don’t - Often psychosis can stimulate tastes, smells and sensations that aren’t really occurring. An example of this would be to feel someone touching your hair when there is no one there, or smelling a strong scent such as petrol when others cannot.
Delusions
A delusion is a belief that is unlikely to be true and that others don’t share. Delusions often fall into one of the following two categories:
- Delusions of grandeur - Delusions of grandeur tend to revolve around the belief that you are incredibly important, rich and/or powerful. For example, someone may believe they are a member of the royal family, or that they have special powers. In some cases, individuals believe themselves to be God or a higher power.
- Paranoid delusions - Paranoid delusions can be incredibly frightening and can lead to the person feeling mistrustful, threatened and suspicious. People may believe they are being followed, that someone is trying to kill them or that they are being controlled.
In addition to hallucinations and delusions, psychosis can also include:
- Disorganised thinking and speech - Hallucinations and delusions can make a person's thoughts and emotions confused and disorganised. A psychotic episode may trigger disturbed and disrupted patterns of thought, leading to rapid and constant speech, abrupt halts in trains of thought and erratic digressions in the conversation topic.
- Lack of self-awareness - A person experiencing psychosis may be unable to recognise that their behaviour is in any way bizarre or out of character. For example, they may recognise delusions in other people but believe they are perfectly healthy in body and mind. Many people experiencing psychosis believe that their delusions or hallucinations are real, which can be confusing, frustrating and in some cases, very frightening. Self-awareness of psychosis generally sits on a spectrum, however, so some people may be able to identify these symptoms in themselves.
This combination of symptoms can severely disrupt and alter thoughts, emotions, behaviour and awareness. In addition, each individual’s experience of psychosis will be unique. Some may experience psychosis only once, others will go through a number of short bouts and some individuals will live with psychosis long-term.
The effects of psychosis differ for each person, and some may experience it once whereas others experience short episodes throughout their lives. It can be that psychosis is not always distressing, an example of this could be seeing the faces of loved ones who have died or hearing their voices, which could be comforting.
- Joshua Miles (BA, MSc, BPC, BACP) Accredited Psychodynamic Psychotherapist
Psychosis causes and diagnosis
Psychosis can be a symptom of lots of different mental health problems, and so is not diagnosed as a standalone condition. If you have one or more of the following diagnoses, then you may experience psychosis. If you experience psychosis (and other symptoms) then you may be diagnosed with one of the following:
- severe depression
- schizophrenia
- bipolar disorder
- schizoaffective disorder
- paranoid personality disorder (PPD) or schizotypal personal disorder
- post-partum psychosis
- delusional or paranoid disorder
If you experience psychosis for less than a month and your symptoms aren't described by another diagnosis, you may be diagnosed with brief psychotic disorder.
Causes of psychosis are of course not limited to the above, and there are many varying explanations as to why people experience it. Below are some additional avenues of thought regarding possible causes:
- Genetics: According to experts you are more likely to experience psychosis if a blood relative has been affected in the past.
- Physical injury: If you have sustained a head injury, for example, this may increase the likelihood of you experiencing symptoms.
- Severe lack of sleep: Severe sleep deprivation can increase the risk of hallucinations.
- Extreme hunger: If you have not eaten for a long period of time, are not getting enough food overall or if you have low blood sugar, you may be at a higher risk of hearing voices.
- Trauma or abuse: If you have experienced abuse or an exceptionally traumatic event, you are at a higher risk of experiencing psychosis.
The diagnosis you receive will take into account how severe your episodes are, how often they occur and whether you experience them alone or in conjunction with additional symptoms.
Treatment for psychosis
While there is no one-size-fits-all approach, with the right support and treatment, it is possible to manage the symptoms and/or make a recovery. In many cases, the symptoms won’t vanish entirely and you may experience them from time to time - but with the right support and advice, you can find ways of coping so that they are less distressing and disruptive.
As a precursor to the implementation of any psychosis treatment plan, your mental healthcare provider should inform you of all possible available options - taking into account your preferences, environment and possible physical causes before you make a decision together on which treatment would be most suitable.
Below are some of the treatment options available. Please know that what works for one person may not work for another, so it is important you speak to a medical professional and/or counsellor and ask as many questions as possible to get a thorough understanding of the treatment and whether it is right for you.
Talking therapies
Talking therapies help you to understand and explore how you are feeling so that you can address negative thoughts and feelings and develop coping strategies to pave the way for positive change.
In the case of psychosis, a professional counsellor or psychotherapist may be able to help you challenge paranoid feelings while also helping you address anxiety or depression that may have developed as a result of experiencing psychotic episodes.
Talking therapies that have been found particularly beneficial for psychosis treatment include:
Counselling
Counselling for psychosis will provide you with an opportunity to explore your thoughts and feelings and the impact they may be having on your behaviour. As part of counselling you will also discuss any past experiences that may have influenced your present situation – and will find ways and methods of addressing them.
CBT for psychosis
CBT for psychosis revolves around the way you think (cognitive) and the way you behave (behavioural). It is designed to help you recognise and foster the idea that it is possible to change or recondition these thoughts and behaviours in order to overcome specific problems.
Psychoanalytical and psychodynamic therapies
These therapies take a more in-depth look into unconscious thoughts and perceptions to identify issues from your past that may have acted as a trigger for your current experiences.
Arts therapies
The National Institute for Health and Care Excellence (NICE) has recommended therapies such as music therapy and art therapy as treatment avenues for schizophrenia and other related conditions. These therapies harness your creative side and use it as a vehicle for communication and expression.
Medication
In most instances, individuals diagnosed with a psychotic illness will be offered antipsychotic drugs that may help to control symptoms and any associated anxiety and/or depression. In cases where antipsychotic drugs aren’t suitable or additional medication is needed to treat severe depression or mania, antidepressants or mood stabilisers may be prescribed.
Hospital admission
If you have experienced a very severe episode of psychosis and are feeling distressed, you may require treatment as an inpatient. In a hospital, you can receive around-the-clock care and support to help you get back on your feet.
In some circumstances, it’s considered necessary for both your own health and safety and for the health and safety of others that you be detained under the Mental Health Act. This can be an incredibly frustrating and upsetting experience but is not a decision that is taken lightly.
When someone has been under certain treatment sections of the Mental Health Act, it then becomes the duty of the healthcare provider to plan fully funded aftercare for after hospital discharge – with the aim of helping individuals to settle back into society and their lives.
Experiencing psychosis for any period of time is distressing, confusing and difficult. However, seeking support for yourself is the first step you can take to looking after yourself.
- Psychodynamic psychotherapist Joshua Miles (BA, MSc, BPC, BACP Accred.) writes in his article, Understanding psychosis and psychotic episodes.
How can I help myself?
While professional help will be needed to treat psychosis, there are of course some personal steps you can take to help you manage symptoms more effectively.
Support groups
Support groups provide a place for you to meet other individuals with similar life experiences so that you can outlet your thoughts and feelings and share tips for coping. Individuals who attend support groups often report that this supportive and collaborative environment makes them feel more accepted, less isolated, more understanding of their own and other people’s experiences and more confident about making decisions.
Lifestyle changes
It’s surprising what a simple change here and there can do in terms of helping to improve your physical and mental well-being. For example:
- Eat, snack and drink regularly in order to minimise psychosis triggered by unstable blood sugar and/or hunger.
- Be sure to get enough sleep so as to avoid stress and worry associated with tiredness – both of which can make it more difficult to manage symptoms.
- Try some relaxation exercises such as mindfulness or yoga, or treat yourself to an alternative therapy such as reflexology or aromatherapy to reduce any stress you may be feeling.
- Keep yourself busy by cooking, gardening, meeting up with friends etc. These activities can boost self-esteem and keep you connected with the world around you.
Know your triggers
If you tend to experience repeated psychotic episodes then you may find starting a day-to-day diary, in which you record daily activities and mood, helpful. It may be that after you have jotted down a few weeks' worth, you are able to identify patterns or times at which you are vulnerable, and things that have been helpful so that you can then use this information to help you anticipate, prevent or manage an episode.
What should I look for in a counsellor?
While are there no specific laws in place which stipulate the level of training and experience a counsellor or psychotherapist must have in order to treat psychosis, the National Institute for Health and Care Excellence (NICE) has issued guidelines that outline recommended psychological treatment.
It is also important to note that counsellors and psychotherapists offering arts therapies such as music therapy and art therapy, must be registered by law with the Health and Care Professions Council (HCPC) in order to deliver these therapies to clients.
Please find the NICE guidance below:
Psychological and psychosocial interventions
- Offer CBT for psychosis or schizophrenia sufferers. This can be started either during the acute phase or later, including in inpatient settings.
- Offer family intervention to all families of people with psychosis or schizophrenia who live with or are in close contact with the service user. This can be started either during the acute phase or later, including in inpatient settings.
- Consider offering arts therapies to all people with psychosis or schizophrenia, particularly for the alleviation of negative symptoms. This can be started either during the acute phase or later, including in inpatient settings.
- Arts therapies should be provided by a Health and Care Professions Council registered arts therapist with previous experience of working with people with psychosis or schizophrenia. The intervention should be provided in groups unless difficulties with acceptability and access and engagement indicate otherwise. Arts therapies should combine psychotherapeutic techniques with activity aimed at promoting creative expression, which is often unstructured and led by the service user.
